Homestead_Belcher (2) •
'TALE FORM!3w du,...) nrwwtLl POEM TS-IA
APPROVED BY AgL BOW)M MVYR EN1 C.yw PEGV(Rtam BY nit DEPARTe.1{f LOCAL GOVER MrNT FINANCE IC 1.1.1-2:4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 individuals and married couple.are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than etcr for homestead fraud homestead fraud causer higher tax bills for all:therefore.
HEA 1347-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receie the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will be kept conlidentinl and can only be accessed by atehorired county officials The Ikpanaent of
Local Government Finance will hiss this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY L\FORMATION
Taipaver Name Property Address
Belcher, !key R/
Old US 41
__ ,—_ _. __ _ _ _
— — _ _ _ _ _ _ - Hazleton IN 47640 __
364
!key R/ Belcher
6118 N Old US Hwy 41 State Parcel Number Legal Description
Hazleton IN 47640-9220
IIIIIIliiiiilletilluIIIItililii11Illllllll' Illnlllntll -1 00-000.040-018 010-00040-OO PT,NE 121117.852 AC
V 1 7.011 11
0.ai
PART 2:TAXPAYER iNFORMATION
Owner I First Middle Last
zsEy iNy B E. LQH E ft (SR)
t g Address(number chid street,city,sate,andZIP code)- — -- — — — — — _teal Same m propcny uddiess—-- — --
L01 Ig )3 01D Us HuV 41 H. I-ZL .T€ owl 2"N.bia N 4-740-9z4M
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date